Light of the family: Formative research supports a child as change agent approach for adult obesity prevention among American Indian households

High obesity rates among Americans Indians are associated with contextual factors that influence food and physical activity-related behaviors. Formative research in Michigan consisted of 105 interviews (workshops, in-depth, focus groups, and household groups). Contextual factors include historical trauma, cultural values and traditions, family and extended family networks, poverty, unemployment, alcohol and drug abuse, household factors, school system, parenting, the environment, and infrastructure. Children are "revered," "protected," and deemed as the "light of the family." Children as change agents can impact household food-related behaviors and physical activity by “sharing” their learned knowledge from school, by “encouraging,” “reminding,” and “asking” for healthier foods and, asking for cultural and sports-related activities. Adult caregivers “listen” to their children, are “inspired” by children's “energy,” and engage with their children in an exchange of knowledge and engage in activities out of "concern" for their children's wellbeing. Children are already recognized by adults as being influential in households with other children, elders, and parents' health behaviors. While caregivers are enthusiastic about children's agency in adult behavior change, they are concerned about potential unintended consequences of children participating in an obesity intervention trial, including stigma associated with body size and eating disorders. Existing school curricula, resources, and teacher buy-in make the school a promising venue for implementing a change agent intervention trial. Baseline adult impact assessment data suggests potential for a child as change agent approach. Intervention trials for AI communities will use a novel child as change agent approach for improving health behaviors among adult household members.